From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, College of Medicine, University of Arizona, Tucson, Arizona.
J Trauma Acute Care Surg. 2020 Oct;89(4):723-729. doi: 10.1097/TA.0000000000002851.
Angioembolization (AE) is an integral component in multidisciplinary algorithms for achieving hemostasis in patients with trauma. The American College of Surgeons Committee on Trauma recommends that interventional radiologists be available within 30 minutes to perform emergent AE. However, the impact of the timing of AE on patient outcomes is still not well known. We hypothesized that a delay in AE would be associated with increased mortality and higher blood transfusion requirements in patients with blunt intra-abdominal solid organ injury.
A 4-year (2013-2016) retrospective review of the ACS Trauma Quality Improvement Program database was performed. We included adult patients (age, ≥18 years) with blunt intra-abdominal solid organ injury who underwent AE within 4 hours of hospital admission. Patients who underwent operative intervention before AE were excluded. The primary outcome was 24-hour mortality. The secondary outcome was blood product transfusions. Patients were grouped into four 1-hour intervals according to their time from admission to AE. Multivariate regression analysis was performed to accommodate patient differences.
We analyzed 1,009,922 trauma patients, of which 924 (1 hour, 76; 1-2 hours, 224; 2-3 hours, 350; 3-4 hours, 274) were deemed eligible. The mean ± SD age was 44 ± 19 years, and 66% were male. The mean ± SD time to AE was 144 ± 54 minutes, and 92% of patients underwent AE more than 1 hour after admission. Overall 24-hour mortality was 5.2%. On univariate analysis, patients receiving earlier AE had decreased 24-hour mortality (p = 0.016), but no decrease in blood products transfused. On regression analysis, every hour delay in AE was significantly associated with increased 24-hour mortality (p < 0.05).
Delayed AE for hemorrhagic control in blunt trauma patients with an intra-abdominal solid organ injury is associated with increased 24-hour mortality. Trauma centers should ensure timeliness of interventional radiologist availability to prevent a delay in vital AE, and it should be a focus of quality improvement projects.
Prognostic, level III.
血管栓塞术（AE）是实现创伤患者止血的多学科算法的一个组成部分。美国外科医师学院创伤委员会建议，介入放射科医生应在 30 分钟内能够进行紧急 AE。然而，AE 的时间对患者预后的影响尚不清楚。我们假设，在钝性腹部实质性器官损伤的患者中，AE 的延迟与死亡率的增加和更高的输血需求有关。
对 ACS 创伤质量改进计划数据库进行了一项为期 4 年（2013-2016 年）的回顾性研究。我们纳入了在入院后 4 小时内接受 AE 的成人（年龄≥18 岁）患者，排除了在 AE 前接受手术干预的患者。主要结局是 24 小时死亡率。次要结局是血液制品的输注。根据患者从入院到接受 AE 的时间，将患者分为四个 1 小时间隔组。采用多变量回归分析来适应患者的差异。
我们分析了 1009922 名创伤患者，其中 924 名（1 小时 76 名；1-2 小时 224 名；2-3 小时 350 名；3-4 小时 274 名）被认为符合条件。平均年龄±标准差为 44±19 岁，66%为男性。AE 的平均±标准差时间为 144±54 分钟，92%的患者在入院后 1 小时以上接受 AE。总体 24 小时死亡率为 5.2%。在单因素分析中，接受早期 AE 的患者 24 小时死亡率降低（p=0.016），但输血量没有减少。回归分析显示，AE 每延迟 1 小时与 24 小时死亡率增加显著相关（p<0.05）。
在有腹部实质性器官损伤的钝性创伤患者中，为控制出血而延迟 AE 与 24 小时死亡率增加有关。创伤中心应确保介入放射科医生的可用性的及时性，以防止重要的 AE 延迟，并应将其作为质量改进项目的重点。
预后，III 级。
